Les thérapies cognitives et comportementales sont recommandées par la Haute Autorité de santé pour la prise en charge de la lombalgie chronique. Si elles sont développées sur le plan individuel, les services de santé demandent aux praticiens de mettre en place des prises en charge de groupe afin qu’un nombre plus important de patients puissent en bénéficier. Sur ce point, les recherches internationales montrent des effets irréguliers. Les recherches françaises sont, quant à elles, confidentielles. L’amélioration de l’efficacité des TCC suppose de mieux prendre en compte les facteurs psychologiques impliqués dans la lombalgie chronique afin d’élaborer un programme thérapeutique qui visera à les modifier. Cette étude porte donc sur la création et l’évaluation d’un programme TCC de groupe en cinq séances auprès de patients souffrant de douleurs chroniques. Les séances visent un facteur ou un processus psychologique maintenant la douleur chronique (anxiété, dépression, catastrophisme, croyances, coping, etc.). Les patients sont évalués à deux temps avec des échelles standardisées et validées : préalablement à la prise en charge (T0) et après la prise en charge (T1). Les scores des patients sont comparés, d’une part, entre T0 et T1 et, d’autre part, à ceux d’un groupe témoin. Les résultats montrent une amélioration significative du retentissement fonctionnel de la douleur et des facteurs psychologiques (anxiété, dépression, catastrophisme, croyances peur-évitement) grâce à la prise en charge TCC comparativement au groupe témoin. Ces premiers résultats laissent entrevoir le bénéfice engendré par une prise en charge psychothérapeutique spécifique aux patients souffrant de lombalgie chronique et montrent la nécessité d’approfondir la compréhension des mécanismes sous-jacents impliqués dans le lien entre douleur et facteurs de risque.

Chronic or acute exposure to stressful situations, notably at work, alters the health of workers and can lead to the development of specific forms of physical pain (musculoskeletal disorders, low-back pain). A large body of research has sought to identify modifiable risk factors (such as depression, anxiety, catastrophizing, fear-avoidance beliefs) to form the basis of interventions aimed at preventing the development of prolonged incapacity (Pincus and McCracken, 2013; Sullivan, Lynch and Clark, 2005; Turk and Gatchel, 2002; Vlaeyen and Linton, 2000). However, despite recommendations of the Haute Autorité de santé (the French National Authority for Health), there is little research into psychotherapy combined with CBT in France. Numerous international studies on the efficiency of CBT show modest and irregular effects due to a misunderstanding of psychological factors, imprecise theoretical foundations or groups which are too heterogeneous in nature (Mansell, Kamper and Kent, 2013; Morley and Keefe, 2007; Morley, Williams and Eccleston, 2013).

Through evaluation of the level of risk and vulnerability factors, this research aims to analyse the efficiency of group CBT treatment for patients suffering from chronic, work-related low-back pain. The main hypothesis is that group CBT treatment associated with a physiotherapy programme (experiment group) will be more effective than standard physiotherapy (control group). Patients receiving CBT treatment will have less intense levels of pain, functional repercussions, risk and vulnerability factors than patients in the control group.

The CBT programme consisted of 5 sessions. Each session was divided into 4 parts: 1) psychoeducation, 2) work on a psychological factor or process involved in the maintenance of chronic pain (stress and pain with the evaluation and modification of automatic dysfunctional thoughts, anger management and self-assertion), 3) setting up of tools and 4) prescription of inter-sessional tasks. Systematic evaluation of pain, its functional consequences, risk and vulnerability factors was carried out with the help of a 13-scale test at the start and end of the therapy, and at 6-month follow-up. There were two groups of patients: a control group (only physiotherapy) and a CBT group (psychotherapeutic treatment and physiotherapy). Nonparametric statistical analyses (Wilcoxon and Mann-Whitney U tests) were carried out with the help of SPSS software.

Statistical analyses did not show a significant difference between the two groups in T1. Between T0 and T1 a significant decrease in functional consequences of pain on mood (Z=2.03; P=.03) and a significant trend towards the reduction of functional consequences on daily life (Z=1.87; P=.06) and on work and on leisure activities for the CBT group (Z=1.78; P=.07) were observed. With regard to risk factors, analyses show a significant decrease (P<.05) between T0 and T1 in anxious state (Z=2.37), depression (Z=2.37), catastrophizing (Z=2.11) and fear-avoidance beliefs linked to physical activity (Z=1.90) levels for patients on the CBT programme. Analyses indicate significant differences in T1 concerning average total scores of difficulty with emotional regulation and its various dimensions: “difficulties in adopting goal-orientated behaviour”, “lack of emotional conscience”, “limited access to emotional regulation strategies” and “lack of emotional clarity”. These different averages are higher for the control group. In addition, a significant increase in certain vulnerability factors between T0 and T1 was observed for the control group: the total score of emotional regulation difficulties, “lack of emotional clarity”, as well as focus on rumination.

This preliminary study suggests the importance of combining CBT group treatment with physiotherapy treatment for patients suffering from chronic, work-related low-back pain. On one hand, in accordance to our hypotheses, the specific effect of CBT treatment on variables linked to functional consequences and psychological risk factors was observed. On the other hand, the CBT programme seemed to have a protective effect on vulnerability factors. These observed clinical benefits should be extended to a larger number of groups. It would seem to be pertinent to work on a transdiagnostic and processual approach in order to identify underlying psychological mechanisms in the link between pain and risk factors/emotional problems, notably emotional regulation problems, in order to improve treatment efficiency (Linton, 2013; Linton and Bergbom, 2011).